07-102741 At. RE VED •
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y a '�'ERMIT
COMM'°AV NUE SO
TH•PCERNCES SF MF CO ME EL PL DEE 0
33325 8TM AVENUE SOVIN•PO BOX 9718
z ° ;WAY.
�FAX455a 27609 APPLICATION / 1
www.cituolkdealwae.eom
The of • • is re.uired i ormation-an incom•lete a••lication will not be acre•ted. Please •Tint le, •I. (in ink)or ty.e.
• PROPERTY INFORMATION
SITE ADDRESS 57,5. j.-336.,441 'i(1.i d.; /54- .#) (K 3,;_(1,,-L 1,,;•.,,,9g elc?.3 SUITE/UNIT'it
ASSESSOR'S TAX/PARCEL M CL ( / 1/ 8 C? - [[ ' L 9 0 /451 6'C
LOT SIZE(gnl /
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detniled description of work included on this permit only)
A )i I 4_,(7 1 AT iikk:c. (br2QJ'e,i5 AA-)t7;5;6,A,44.- tZ--t(94-1.^_beZIL 7a ;4I'L Glxl5-Il:'41 %-iizi-
4t-A2'IA (nti7-fief }NAA7124_ AAD 4li) &)Q7t,'ie AT10A..' ;a -THA,, A..'i t..i `,;1(t Ai4t_
!:•z eF1n..10, L, ;::c72 i?... 3?.)r 'foe i"S.( f`. TwivAk i' 1_rr.t erto crii_PFc.n:i.
1
PROJECT NAME(Name of Business or Owner Lost Name) (' ')1 P U s C.X.Ai)7'.(../Wm y Yt t-)(AL-7H
In PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER /T$ ) Fe-.7•i(2rIL. 6,^4-/ (n(c'_ip. ( ) -
MAIUNG ADDRESS CITY.STATE.ZIP
•
-0j 5• .3.3(rtYi Sr rx.6 (LAtL_(-oA-y W/4-1 Igor, 3'
CONTRACTOR COMPANY NAME APPLICANT NAME
OFFICE PHONE
Srn ITN rlRh_i=t)SiifillS ,KC,b-e_ i t'o'N204.4LeXC (?`'3) 4/6 -Zan 11
MAILING ADDRESS J CITY.STATE.ZIP C/� 7 CELL PHONE
CITY OF FEDERAL WAY BUSINESS CENSE-NUMBER �� ,T'EXPIRATION D� L C FAX NUMBER
l 1-3L- e` 0 2 - .f5 I Z / S/ "Cg (z53)92 - C'172 ,
CONTRACTOR'S REGISTRATION NUMBER(copy of card regolrad with oath applcatioa) EXPIRATION DATE
5 1M L Z E.1 L 5 2 1 L. Q i2 / 2?_ /ng
APPLICANT COMPANY NAME APPLICANT NAME
OFFICE PHONE
541 I%H fiQ __‘.,;e15.;77i441�. P_CAj tf'T--6,5Q01 CP 4- (7E 3) Zi/fl -2C1°-�
MAILING ADDRESS J CITY.STATE.ZIP CELL PHONE
//C'l ' SI/f 1 4W E-A Tileeni }- cRfA9a y'c`,/ ( ) -
REIATIONSHIP TO PROJECT '/ FAX NUMBE�R7
0 Architect 0 Tenant 0 Agent ,Other(Describe)CS./C.,t). 12... (2 j3 ) /2G -C-27�
CONTACT NAME PRIMARY PHONE
E-MAIL ADDRESS
lee/0 tri—(1 1126 Id Lr--F (2_C3 ) z '8 -Zee'`
LENDER °'':i•'",:'''' a r.i;r {F:r,s'i]'. ': NAME
:;in rs{;i 4,,,,:_,•,:t:',-4,,h,'1,-..
y:, rT(r1_:11:__l;i,; .�,r),iii._ ,f
MAILING ADDRESS CITY.STATE.ZIP
�/
• DETAILED BUILDING INFORMATION
EXISTING USE WPI// PROPOSED USE t)/-'-I-(e_e_-
cz ca
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ Q_220.
SPRINKLERED BUILDING? 0 YES *'NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ,(NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE )"PACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE ❑PRIVATE(SEPTIC)
~ • •
PROJECT FLOOR AREAS - -
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE) / `
(�. � I ' fl/ Its L'C�C
DECK(COVERED?) /
GARAGE ❑ CARPORT❑
PROPOSED •r.,. } e
� y_NUMBER OF FLOORS4.aZ; • SVS .<
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECILANICAL
Value of Mechanical Work S
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(Com..,cw) WOODSTOYES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS!.r1nb/Shower Combo) SHOWERS WATER CLOSETS rrouou MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLET'S SUMPS RAINWATER SYSC
WASHING MACHINES URINALS HOSE BMBBS
_ LAVS)e.m..o.,s,.!rr) VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge,and further,that I
am authorized by the owner of the above premises to perform the work for which the permit application is made. I further agree to hold
harmless the City of Federal Way as to any claim Iincluding costs,expenses,and attorneys'fees incurred in the investigation and defense of
such claim),which may be made by any person,including the undersigned,and filed against the City
arises out of the reliance of the city,includingits of Federal Way,but only where such claim •
officers and employees,upon the accuracy of the information supplied to the city as a part of
this application.
NANAME/TITLE /l DATE '?/9` c
(Signature) title)
RELATIONSHIP TO PROJECT ❑ er 0 Agent Contractor 0 Architect 0 Other
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Bulletin*100-January 7,2005 Page 2 of 4 k\Handouts\Permit Application